CD30 positive systemic anaplastic large cell lymphoma - brentuximab vedotin initial PBS authority application form (PB123)
Use this form for a patient starting initial Pharmaceutical Benefits Scheme (PBS) subsidised treatment with brentuximab vedolin.
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Page last updated: 20 February 2020
This information was printed 6 January 2021 from https://www.servicesaustralia.gov.au/organisations/health-professionals/forms/pb123. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.